- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $8.34 / $10.39 / $13.56
| Facility | 26 | $8.34 | $10.39 | $13.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.01 / $34.78 / $56.77
| Professional | | $25.01 | $34.78 | $56.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $6.73 / $9.85 / $13.13
| Professional | 26 | $6.73 | $9.85 | $13.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $17.41 / $24.49 / $43.78
| Professional | TC | $17.41 | $24.49 | $43.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.50 / $29.50 / $29.50
| Professional | | $29.50 | $29.50 | $29.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $19.05 / $19.05 / $19.05
| Professional | 26 | $19.05 | $19.05 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.97 / $42.30 / $51.32
| Professional | | $37.97 | $42.30 | $51.32 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.49 / $12.17 / $15.72
| Professional | 26 | $9.49 | $12.17 | $15.72 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.57 / $31.61 / $38.03
| Professional | TC | $27.57 | $31.61 | $38.03 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.62 / $7.62 / $8.24
| Professional | 26 | $7.62 | $7.62 | $8.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.62 / $31.64 / $56.66
| Professional | | $19.62 | $31.64 | $56.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $5.19 / $9.27 / $15.62
| Professional | 26 | $5.19 | $9.27 | $15.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $14.42 / $23.78 / $41.59
| Professional | TC | $14.42 | $23.78 | $41.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $33.08 / $51.60
| Professional | | $23.65 | $33.08 | $51.60 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $7.00 / $9.44 / $14.68
| Professional | 26 | $7.00 | $9.44 | $14.68 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $16.60 / $23.46 / $35.19
| Professional | TC | $16.60 | $23.46 | $35.19 |